“50-50 po ang pasyente natin.” When did I last hear that said? When did I last say it myself? I remember more than a decade ago, I did say that to the daughter of my patient. My elderly patient was admitted for UTI and she was septic. Her daughter kept saying to me, “But she’s going to be alright Doc? She is right?” I wanted to say that her condition was “guarded” but I felt that saying “50-50” would be better understood because she was too optimistic. My patient did get better and I was able to send her home.
I’ve also encountered patients with rare syndromic disease where I’ve had to say, “I don’t know.” I know it’s difficult for patients to hear that but that’s the truth. I find that explaining what the plan is to get a diagnosis helps. That takes time, and often needs confirmation with the patient if it’s been understood or if they have questions, despite being overwhelmed. It also is difficult when the patient says, “What would you do, if it were you?”
Tonight, let’s discuss communicating uncertainty, from the viewpoints of both the patient and the doctor at the #HealthXPH chat 9 pm, Manila time.
T1. For MDs: Think of a time you said “50-50” or “we’ll see” when you actually had a clearer picture. What stopped you from being more direct?
T1. For patients: Has a doctor ever given you a vague answer when you sensed they knew more? How did that make you feel?
T2. For MDs: Medical training rewards certainty. How does this shape how we handle not knowing as practicing clinicians?
T2. For patients: What actually reassures you when you’re sick? Knowing the answer, or knowing your doctor has a plan and will be honest with you?
T3. For MDs: Is “I don’t know” ever the kindest thing a Filipino doctor can say? What would need to change for it to become normal
T3. For patients: What would help you feel safe when your doctor says “I’m not sure yet”?
I used Claude as a Socratic thinking partner to develop this topic and refine the questions. The topic, framing, and final questions emerged from the dialogue. Claude challenged my assumptions more than it generated content.